77 Pharmacy Inc
Organization Active NPI Community/Retail Pharmacy · Jackson Heights, NY
NPI 1194499343 · NPPES record last updated Nov 21, 2024
Key facts
- NPI
- 1194499343
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- 77 PHARMACY INC
- Practice address
- 8215 Roosevelt Ave
Jackson Heights, NY 11372-7034 - Phone
- (718) 898-7777
- Fax
- (718) 898-7775
- NPI assigned
- Aug 2, 2021
- Organization subpart
- No
Authorized official
- Name
- Ronald Rivas
- Title
- Owner
- Phone
- (718) 684-1595
Corporate family (same tax ID) 1
Practitioners 1
-
Jae Lee, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211013001881 | NY | DME Supplier - Pharmacy | 2264830702 | Practice locations: Jackson Heights, NY |
| O20220727000837 | NY | Part B Supplier - Pharmacy | 2264830702 | Practice locations: Jackson Heights, NY |
National Provider Directory
- Tax ID family
- 77 Pharmacy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
8215 Roosevelt Ave
Jackson Heights, NY 11372-7034
Mailing address
8215 Roosevelt Ave
Jackson Heights, NY 11372-7034
Phone (718) 898-7777
Other names
- 77 Pharmacy
Other providers in Jackson Heights, NY
- 37TH Ave. Pharmacy Inc.
- 63Rd Drive RX, Inc.
- 63Rd Drive RX, Inc.
- 75TH Street Medical PC
- 77 Dental PC
- 77 Pharmacy Inc
- 82ND Dental PLLC
- 84 Street Medical PC
- 90-15 Roosevelt Pharmacy Corp
- 9301 Health Medical Corner PC
All providers in Jackson Heights, NY · Community/Retail Pharmacy in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.